The present disclosure relates to surgical systems and procedures for closing an orifice or other opening in bodily organs, vessels, or other tissue. More particularly, it relates to devices and methods that are amenable to minimally invasive surgical procedures, and are readily deployed in manners facilitating closure of an internal opening.
The need to surgically proximate and close an opening in tissue arises under a plethora of difference circumstances. Tissue defects, such as wounds, are one such example. Treatment of a skin surface wound typically entails suturing edges of the wound together. In many instances, however, the tissue opening to be treated is internally located, and thus not readily accessible by a surgeon otherwise attempting to utilize a conventional suture thread to effectuate repair of the opening. Access to internal tissue openings of these types through invasive surgery introduces a high level of risk that can result in serious complications for the patient, especially where the opening or orifice in question is located at or near a vital organ. One example of an internal tissue opening of this type is a trans-apical orifice formed through a wall of the heart at the ventricular apex.
By way of reference, various medical procedures on the heart can be performed inside the heart (endocardial) and on the outside of the heart (epicardial). Endocardial procedures require access to the interior of the heart, which can be accomplished percutaneously through the vasculature or directly through the patient's chest and heart wall. With direct access techniques, a conventional location at which the interior of the heart is accessed is via an opening formed at the ventricular apex of the heart, commonly referred to as trans-apical access. For example, trans-apical prosthetic heart valves have recently been developed that are delivered to the native heart valve to be repaired via a transcatheter approach in which the catheter is inserted through an opening made at the ventricular apex. Other endocardial procedures similarly entail forming an access opening through a wall of the heart, and can include other cannula-like instruments being inserted through the access opening. Upon completion of the procedure (and removal of the catheter or other cannula-like device), the access opening must be closed. Conventionally, sutures are employed; however, manually sewing a suture to the cardiac tissue can be time-consuming and difficult, especially with minimally invasive and/or transcatheter procedures. Alternatively, it has been suggested that a plug can be inserted into the heart wall opening. Unfortunately, complete closure may be difficult to achieve, and additional procedures must be performed (e.g., manually sewn suture) to secure the plug to the cardiac tissue.
Cardiac apical access openings are but one example of an internal opening or orifice requiring surgical closure. Paravalvular leaks, vessel repair, gastric incisions, etc., present similar concerns. While manual suturing of the opening is well-accepted, in many instances this technique is less than optimal. Therefore, a need exists for systems and methods for closing an internal bodily opening or orifice, such as an apical heart wall opening.